Objective To evaluate the clinic efficacy and the side effects of erythromycin and azithromycin in the treatment of children with mycoplasma pneumonia. Methods All patients were randomly assigned to the erythromycin group (n = 65) or azithromycin group (n = 47). Erythromycin group received erythromycin 20~25 mg/kg for 10~14 days and azithromycin group received azithromycin 10 mg/kg for 3 days weekly, for 2 weeks. The clinic efficacy and side effects were observed. Results The terms of fever was shorter in erythromycin group than those in azithromycin group (P 0.05). There were no differences in terms of cough, pulmonary rale. The rates of gastrointestinal tract reaction and injection site pain were higher in erythromycin group than those in azithromycin group (P 0.05). Conclusion Erythromycin is still first choice drug in the treatment of children with mycoplasma pneumonia in early stage.